Sample Record for 2019-09-04-4
Note: Fields with no data or with a value of "Unknown" will not be displayed on the print out.
Project Information
Project ID: 213856 DEA: 112888U4 EFIS: 1118000199
QA Service Level: 1
DIST-CO-RTE-PM: 11-SD-11,125,905-Various
Work Description: CONSTRUCT FREEWAY TO FREEWAY CONNECTORS AND 4-LANE HIGHWAY FACILITY
Location Description: SAN DIEGO COUNTY AT VARIOUS LOCATIONS
Contractor Name: Skanska USA Civil West CA
Contractor Address: 1995 Agua Mansa Road, Riverside, CA 92509
Resident Engineer: Carlos Covarrubias Structure Rep.: Wade Durant
Sample Information
DIME Sample ID: 2019-09-04-4
TL Number from the TL Form:
Sample Submitted By Organization: CT HQ - QASI Los Angeles Field Office
Sample Organization Contact: (858) 285-5797
Type of Sample: Quality Assurance
Type of Material: SMTL TM5 - Headed Bars
Sample Taken Date: 09/04/2019
Date that the sample was received by the laboratory/organization performing the testing: 09/10/2019
The quantity of what the sample constitutes: 8 of 225
A brief description of the sample: #14 Grip-Twist Bar Splice Type 2
From where was the sample collected: Fabricator
Laboratory sample identification:
Structure unique identifier:
Structure name:
The fabricator/manufacturer/facility name: Integrity Rebar
Material Information
Production or Authorization Testing: Production Testing
Rebar Heat Number(s): 033695
Head Manufacturer Lot Number(s): A192336, MM18107398
Rebar Size: 14
Headed Bar Model Name: 10A Taper Threaded Doughnut
Size of Head: Full Size - 9x
Head Connection Type: Taper Threaded
Head Shape: Circular
Rebar Manufacturer: CMC Rebar
Head Manufacturer: Barsplice
Head Fabricator: Integrity Rebar Placers
Material Standard Code: ASTM A706
Headed Bar Unique ID:
Test Results
